| NPI | 1720473804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: MI 4301502651) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301502651) |
| Enumeration Date | 2015-04-05 |
| Last Update Date | 2022-09-15 |